This study shows that in post-cardiac surgery patients a significant reduction in VAS scores can be safely realized by a nurse-driven protocol. Furthermore, a reduction in time to achieve an acceptable pain score (VAS < 4) was realized.

Propionibacterium acnes PVE is a rare complication after valve surgery. Redo surgery is often required. Treatment of the dysfunctional prosthetic aortic valve most often consists of root replacement, in combination with antibiotic therapy.

Objective: Sleeping problems are among the issues most mentioned by patients after cardiothoracic surgery. These problems can have a negative effect on duration of the hospital stay and recovery. In the ward of our cardiothoracic surgery department, a study was initiated to assess the quality of sleep after cardiothoracic surgery. The primary objective was to investigate the effect of cardiothoracic surgery on the quality of sleep. The secondary objective was to investigate the quality of sleep. Correlations with perioperative factors and related issues such as the type of surgery and medication were sought. Methods: A consecutive prospective cohort study was initiated (N = 72). The study used validated questionnaires to assess sleep: the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Verran Snyder-Halpern Sleep Scale (VSH) and the Factors Influencing Sleep Quality (FISQ). Results: The PSQI showed that the quality of sleep one month after surgery was inferior to the quality of sleep before surgery (p-value: 0.03). The efficiency of sleep (time spent in bed) was higher after surgery then before surgery (p-value: 0.01). The VSH showed increased impaired sleep on the third night after surgery. The most disruptive factors were not being comfortable in a hospital bed, pain and the noise of medical devices. Conclusions: The quality of sleep after cardiothoracic surgery is worse when compared with the preoperative situation. The chief influencing factors are discomfort in bed, pain and disturbance from medical devices. The use of pain medication does not improve the quality of sleep.

Minimally invasive video-assisted epicardial beating heart ablation for lone atrial fibrillation claims to be safe and effective. We, however, report on three patients with an atrioesophageal fistula after this procedure. The exact pathogenesis of this complication is unknown. All patients presented around 6 weeks after surgery with either fever or neurological deficits. Diagnosis can be made by computed tomography scan. We advocate an aggressive surgical approach with closure of the atrial defect on cardiopulmonary bypass and closure and reinforcement of the esophagus with an intercostal muscle flap in a single-stage surgery. Some caution as to the low-risk character of this procedure seems to be realistic.